Good Faith Estimate / No Surprises Act

Get a good faith estimate

A new rule from the Center for Medicare Services went into effect on January 1, 2022. This rule requires us to give a “good faith estimate” (GFE) to a patient of what our services will cost and how long they may last. The intent of this rule is to prevent clients from getting ‘surprise bills’ which does sometimes happen when seeking emergency care or care in a large system where one service or provider might be covered by your insurance, and another may not. This is less likely to occur in this office where your session fee is clearly communicated. That said, even us little offices are still subject to this rule. We have been given minimal direction as to how to carry it out, but I am taking my best shot with what I know right now.

Here is what we have been told must be in the Good Faith Estimate:

• The patient’s name and date of birth. Well, you know your name and date of birth.

• A description of the psychotherapy or other service(s) being furnished to the patient: 45 minutes of mental health therapy.

• An itemized list of items or services that are “reasonably expected” to be furnished: Therapy sessions.

• Expected charges associated with each psychotherapy session or other service(s): $150/session. Maybe less if your insurance covers some of it. It won’t be more than that per session.

• Your name, National Provider Identifier, Tax Identification Number, and office location where services will be provided.

• A disclaimer that there may be additional items or services that you recommend as part of the treatment that will be scheduled separately and is not reflected in the good faith estimate: Not likely, but if I give you a suggestion or referral source, that will obviously be a different service and different cost.

• A disclaimer that the information provided in the good faith estimate is only an estimate and those actual items, services, or charges may differ from the good faith estimate: There’s your disclaimer.

• A disclaimer that the good faith estimate does not require the private pay patient to obtain psychotherapy or other services from you: Clearly, you are welcome to see me or not see me

If you aren’t using insurance to pay for your care, let your health care provider know in advance. Usually, the provider must give you a good faith estimate of expected charges.

This applies when you don’t have insurance, or are choosing not to use it. You may choose not to use insurance if the service you need isn’t covered, or it’s less expensive if you pay out of pocket.

In most cases, providers and facilities must give you an estimate when you schedule care at least 3 business days in advance, or if you ask for one.

The No Surprises Act: New Protections from Surprise Billing (MN State)

https://www.health.state.mn.us/facilities/insurance/managedcare/faq/nosurprisesact.html

The No Surprises Act protects people from unexpected medical bills (Federal)

https://www.cms.gov/medical-bill-rights

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